bloodjourГематология и трансфузиологияRussian journal of hematology and transfusiology0234-57302411-3042ООО Издательский дом «Практика»10.35754/0234-5730-2024-69-1-8-19bloodjour-512Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESИнфекция COVID-19 у больных, перенесших трансплантацию аллогенных гемопоэтических стволовых клетокCOVID-19 infection in patients undergoing allogeneic hematopoietic stem cell transplantationhttps://orcid.org/0000-0001-9230-6960МироноваД. А.MironovaD. A.

Миронова Дарья Александровна, гематолог отделения химиотерапии гемобластозов и трансплантации костного мозга и гемопоэтических стволовых клеток 

Москва

Daria A. Mironova, hematologist of Department of Hemoblastosis Chemotherapy and Bone Marrow and Hematopoietic Stem Cell Transplantation

125167, Moscow

mrnvdaria@gmail.comhttps://orcid.org/0000-0003-0904-7385ВасильеваВ. А.VasilyevaV. A.

Васильева Вера Алексеевна, кандидат медицинских наук, заведующая дневным стационаром иммунохимиотерапии после трансплантации костного мозга и гемопоэтических стволовых клеток 

Москва

Vera A. Vasilyeva, Cand. Sci. (Med.), head of the Day Hospital of Immunochemotherapy after Bone Marrow and Hematopoietic Stem Cell Transplantation, hematologist

125167, Moscow

vasilievava4@mail.ruhttps://orcid.org/0000-0001-9431-8316ДроковМ. Ю.DrokovM. Yu.

Дроков Михаил Юрьевич, кандидат медицинских наук, руководитель сектора научных исследований химиотерапии гемобластозов, депрессий кроветворения и трансплантации костного мозга 

Москва

Mikhail Yu. Drokov, Cand. Sci. (Med.), head of hemoblastosis chemotherapy, hematopoietic depression and bone marrow transplantation research sector

125167, Moscow

mdrokov@gmail.comhttps://orcid.org/0000-0001-8044-598XЧабаеваЮ. А.ChabaevaYu.  A.

Чабаева Юлия Александровна, кандидат технических наук, заместитель заведующего информационно-аналитическим отделом 

Москва

Yuliya A. Chabaeva, Cand. Sci. (Tech.), deputy Head of the information and analytical Department

125167, Moscow

uchabaeva@gmail.comhttps://orcid.org/0000-0001-6201-6276КузьминаЛ. А.KuzminaL. A.

Кузьмина Лариса Анатольевна, кандидат медицинских наук. заведующая отделением химиотерапии гемобластозов и трансплантации костного мозга и гемопоэтических стволовых клеток

Москва

Larisa A. Kuzmina, Cand. Sci. (Med.), head of Department of Hemoblastosis Chemotherapy and Bone Marrow and Hematopoietic Stem Cell Transplantation

125167, Moscow

kuzlara@rambler.ruhttps://orcid.org/0000-0001-6177-3566ПаровичниковаЕ. Н.ParovichnikovaE. N.

Паровичникова Елена Николаевна, доктор медицинских наук, генеральный директор 

Москва

Elena N. Parovichnikova, Dr. Sci. (Med.), CEO 

125167, Moscow

elenap@blood.ruФГБУ «Национальный медицинский исследовательский центр гематологии» Министерства здравоохранения Российской ФедерацииРоссияNational Medical Research Center for HematologyRussian Federation202418032024691819Copyright © Миронова Д.А., Васильева В.А., Дроков М.Ю., Чабаева Ю.А., Кузьмина Л.А., Паровичникова Е.Н., 20242024Миронова Д.А., Васильева В.А., Дроков М.Ю., Чабаева Ю.А., Кузьмина Л.А., Паровичникова Е.Н.Mironova D.A., Vasilyeva V.A., Drokov M.Y., Chabaeva Y.A., Kuzmina L.A., Parovichnikova E.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.htjournal.ru/jour/article/view/512Введение

Введение. Пандемия COVID-19 изменила условия оказания медицинской помощи гематологическим больным, в том числе перенесшим трансплантацию аллогенных гемопоэтических стволовых клеток (алло-ТГСК). Цель: анализ течения новой коронавирусной инфекции COVID-19 у больных, перенесших алло-ТГСК.

Материалы и методы

Материалы и методы. В ретроспективное исследование включены 87 больных, перенесших COVID-19 после аллоТГСК в период с марта 2020 по январь 2022 г. Трансплантации в большинстве случаев проводили больным острыми лейкозами (77 %) с использованием периферических гемопоэтических стволовых клеток (52 %) или костного мозга (48 %) после кондиционирования в режиме пониженной интенсивности (75 %). Инфекцию COVID-19 считали подтвержденной при обнаружении РНК SARS-CoV-2 методом ПЦР в мазке со слизистой ротоглотки/носоглотки.

Результаты

Результаты. У 71 (81,6 %) больного COVID-19 установлен через год после выполнения алло-ТГСК, у 16 (18,4 %) больных — в течение первого года после алло-ТГСК. Медиана возраста на момент развития новой коронавирусной инфекции составила 42 года. Иммуносупрессивную терапию (ИСТ) на момент дебюта COVID-19 получали 39 (45 %) больных. Проведение ИСТ на момент диагностики COVID-19 отрицательно сказывалось на общей выживаемости (p = 0,0001). Всего 7 (9 %) больных перенесли заболевание бессимптомно, 39 (45 %) — в легкой форме, 23 (26 %) — в умеренной, 10 (11 %) — в тяжелой и 8 (9 %) — в критической форме. TCR-αβ/CD19+ деплеция трансплантата была связана с более легким течением инфекции COVID-19 у больных после алло-ТГСК (p = 0,06). Госпитализация в круглосуточный стационар потребовалась в 24 (27 %) случаях.

Заключение

Заключение. Общая выживаемость была сопоставима в общей группе больных, перенесших алло-ТГСК, по сравнению со здоровыми лицами, заболевшими COVID-19, что обусловлено достаточной степенью реконституции иммунной системы, а также небольшим объемом исследуемой группы. Факторы, повышавшие риск неблагоприятного исхода, — ИСТ и мужской пол.

Introduction

Introduction. The COVID-19 pandemic has changed the conditions for providing medical care to hematological patients, including those who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT).

Objective

Objective: to analyze the course of the new coronavirus infection COVID-19 in patients who have undergone allo-HSCT. Materials and methods. The retrospective study included 87 patients who developed COVID-19 after allo-HSCT in the period from March 2020 to January 2022. In most cases, transplants were performed in patients with acute leukemia (77 %) using peripheral hematopoietic stem cells (52 %) or bone marrow (48 %) after conditioning in a reduced intensity mode (75 %). COVID-19 infection was considered confi rmed when SARS-CoV-2 RNA was detected by PCR in a smear from the oropharyngeal/nasopharyngeal mucosa.

Results

Results. In 71 (81.6 %) patients, COVID-19 was established a year after performing allo-HSCT, in 16 (18.4 %) patients — during the fi rst year after allo-HSCT. The median age at the time of the development of a new coronavirus infection was 42 years. At the time of the COVID-19 debut, 39 (45 %) patients received immunosuppressive therapy (IST). Performing IST at the time of diagnosis of COVID-19 had a negative effect on overall survival (p = 0.0001). A total of 7 (9 %) patients suffered from the disease asymptomatically, 39 (45 %) — in mild form, 23 (26 %) — in moderate, 10 (11 %) — in severe and 8 (9 %) — in critical form. TCR-αβ/CD19+ graft depletion was associated with a milder course of COVID-19 infection in patients after allo-HSCT (p = 0.06). Hospitalization in a 24-hour hospital was required in 24 (27 %) cases.

Conclusion

Conclusion. Overall survival was comparable in the general group of patients with allo-HSCT compared with healthy individuals with COVID-19, due to a suffi cient degree of immune system reconstruction, as well as a small volume of the study group. The factors that increased the risk of an adverse outcome were age and male gender.

   

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The authors declare that there are no conflicts of interest present.